For Cosette Rae, the end of her marriage was death by a thousand clicks.
Rae and her husband — who both worked as computer programmers in the early 2000s — spent hours in front of a computer screen at home and at work.
“We avoided dealing with our problems by working hard," Rae said. "A lot of things that should’ve been dealt with in the moment weren’t dealt with.”
Rae didn’t know that she had developed a disease that has different names in different psychiatric circles — technology addiction, compulsive Internet use or, most commonly, Internet addiction disorder.
What she knew was she couldn’t find time to put her own children to bed.
“There were many times when I didn’t read to my children, even though I wanted to. My interactions with digital media interfered with my ability to be the kind of parent I wanted to be,” Rae said. “It was always, ‘Just five more minutes,’ and then four hours would go by.”
Rae became a psychotherapist and co-founded reSTART, a Washington state recovery center for people who struggle to manage their digital consumption.
Today, digital addiction — whether the fixation is social media, texting, video games or pornography — is a murky term. It's hard to know how many people are affected, but a 2009 study focused on gaming found that about 8 percent of kids ages 8 to 18 worldwide qualify as addicted.
That's about 3 million kids, a number that alarms Dr. Andrew Doan of the U.S. Naval Substance Abuse and Recovery Program in San Diego.
"There is no other drug of choice that you can get for the cost of an Internet connection or for free at a WiFi hotspot that’s as addicting as a painkiller," Doan said.
It isn't unique to America. A 2014 study by psychologist Daria Kuss at the U.K.'s Nottingham Trent University put the digital addiction rate at about 26 percent in parts of Asia. In 2008, China became one of the first countries in the world to declare Internet addiction one of its top public health risks, estimating that more than 20 million of its citizens are Internet addicts.
Yet the American Psychiatric Association has not classified Internet addiction as a disorder in its diagnostic manual, the DSM. Rae says it's high time to make changes.
"We didn’t intend for this to happen when we marched into this brave new digital frontier. But it has," Rae said. "We need to ask ourselves how to erect these safety nets around our activity so we can have a sustainable relationship with technology."
The parameters of digital addiction are not defined, but digital addictions are similar to behavioral addictions like compulsive gambling.
Kuss says there's evidence that Internet addiction can alter brain chemistry.
When the brain experiences something pleasant — for example, winning a video game — the good feelings come from a rush of dopamine, she said. When someone becomes addicted to the activity, neural receptors in the brain become flooded with dopamine and essentially turn off, leading the addict to seek out those feelings aggressively.
When the activity is cut off, it takes time for the receptors to wake up, resulting in depression, mood swings or sleep deprivation. Doan says science needs to classify different kinds of media based on what he calls "digital potency."
"You don't see people getting addicted to PowerPoint," Doan said. "Our challenge is to figure out how potent something like Facebook is compared to something like gaming."
Doan has been studying digital addiction in the Navy. He recently published a landmark paper about the case of one serviceman he diagnosed as being addicted to Google Glass.
Doan reported that the patient used Google Glass about 18 hours a day, became irritable without it and even experienced dreams as if he was viewing them through the Google Glass viewer.
Doan doesn't speak for the Department of Defense, but he says Internet addiction has reached such a level that the U.S. military is actively investigating it as an obstacle to troop readiness. He's frank about what he's seen affect troops so far — a fixation with online pornography.
"We're talking about young, healthy men that come in here with erectile dysfunction," Doan said. "Young men who can't have intimacy with their spouses."
Doan says what he's seeing is an example of the Coolidge Effect — based on the idea that a male mammal will mate to the point of exhaustion for as long as he is exposed to different females. Thanks to the Internet, men now have unlimited access to more pornographic content than ever. Doan says digital-age porn addicts often need to have multiple windows and images open at once to become aroused.
"You use more and more until you can't get an erection without it, so you seek out the next level," Doan said. "It's a drug that triggers a response, just like Viagra."
For three years, Matt McKenna lived and breathed video games. McKenna's game of choice was EverQuest — nicknamed EverCrack for its addictive qualities, McKenna said — an online role-playing game.
As a college student, McKenna played 30 hours at a time, stopping essentially when he passed out.
“The best way I can describe it is I would get a buzz from a headshot or a victory,” McKenna said. "I would eat the fastest food I could find — cereal or something — and I would just play until I couldn't stay up anymore."
McKenna flunked out of school and broke up with his girlfriend, whom he lived with at the time ("I can't believe she stayed with me as long as she did," he said) — all for what he calls his empty reward.
"All I wanted was that buzz. In real life, you have to work hard for that feeling of accomplishment and it's usually well-earned. But in gaming, you don't work hard for it," McKenna said. "Then you start realizing what you're willing to give up to get it."
McKenna tried to find help through recovery website Online Gamers Anonymous, but craved face time with other addicts he could talk to in person, rather than venturing online where he could be tempted to play.
"If it's bad, you don't even want to go on the Internet," McKenna said. "But so many support groups are online."
McKenna turned to Alcoholics Anonymous, but didn't find much support.
"You can't go in there and say you're addicted to gaming," McKenna said. "They don't understand it. They look at you like you're some sort of alien."
McKenna's experience mirrors the same struggle practitioners face to get Internet addiction recognized as a full-fledged behavioral disorder like compulsive gambling.
"(Internet addiction) has serious repercussions we shouldn't overlook," Kuss said. "There are many people out there who are suffering."
The road to recovery is paved with ways to relapse, as McKenna learned. The worst, he says, are free games he can get on his phone. His Internet browser is also a constant reminder of his past.
"I can't choose to not see gaming ads ever again," McKenna said. "All it takes is one click and I'm back into gaming."
When Dr. Hilarie Cash took on a young patient who was addicted to a video game version of Dungeons and Dragons in 1996, she thought of one thing: Her own son.
“What I was seeing was the trickle before the flood,” Cash said. "I didn't want him to end up like that."
Cash, who co-founded reSTART with Rae in 2009, says that technology-centered addictions begin at home.
"I had a husband tell me that his wife checked Facebook on her phone whenever she breast-fed. Disastrous," Cash said. "Many parents have this delusional, self-serving fantasy where they think their kids are going to be smarter because they’re on these devices. But often it's because the parents want to be on their devices."
Because the Internet is part of modern life, reSTART doesn't preach abstaining from digital media, but devising individual use plans.
"I once worked with a woman who was addicted to porn who said that as soon as she sat at her console, she was turned on," Cash said. "This is a very difficult addiction because they can’t just stay away."
Rae says managing digital use can mean website monitoring or filtering software, setting online time limits or buying analog phones rather than smartphones. It's not an easy process, Cash said, which is why families need to start setting up limits from the beginning.
"Many of our social needs can get hijacked on a computer. They can hold a child's attention, but it stops them from interacting," Cash said.
For parents who aren't sure if their children are developing addictive behavior, Kuss suggests an experiment.
"See what happens when you take it away," Kuss said. "Make sure they have good experiences outside of the Internet."
Since she's addressed her habit, Rae says she's rejoined the world in ways she didn't know were possible. She calls it her "reconnecting."
"We all crave human connection. I don’t care how many Facebook pages you have, it is not a hand on the shoulder, the hug, a smile, a laugh, a kiss. That can never be replaced virtually," Rae said. "I didn't know how enjoyable life could be outside the digital world. That's why sustainable technology use is probably one of the most important conversations of our time."
Email: firstname.lastname@example.org, Twitter: ChandraMJohnson